Join Our Network in Texas
Join a network within Prominence Health Plan and help us work toward creating a healthier community.
If you would like to join the Prominence Health Plan network, please fax a Letter of Intent Form to the Contracting Department. You must also complete a current W-9 with your request. Requests can be sent to the contact information listed on the form.
Upon review and approval of your request you will be sent a Contract and a Texas Standardized Credentialing Application (if you have not already submitted one).
Existing Groups with New Practitioners
When adding a new practitioner to an existing group, it is imperative that you let the Credentialing Department know as soon as possible about the addition. The credentialing process can take up to 90 days to complete.
To assist and expedite this process, the Credentialing Department accepts CAQH or a completed Texas Standardized Credentialing Application. For credentialing, please contact the Credentialing Department.
If you have any questions regarding adding a practitioner to your group, please contact the Contracting Department.
- Letter of Intent – TX (PDF) >
- W-9 (PDF) >
- Texas Standardized Credentialing Application (PDF) >
- Provider Profile Sheet >
Please note that all claims received for services provided to an HMO member by a Provider/Practitioner who has not been credentialed and/or contracted with Prominence Health Plan may be denied.